2

Approach to the Interpretation of Muscle Biopsy

C. Sundaram and Megha S. Uppin
Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad
India

1. Introduction
The history of muscle biopsy dates back to 1860 when Duchenne first performed a biopsy on
a patient with symptoms of myopathy. Introduction of enzyme histochemical methods by
Victor Dubowitz in 1970 revolutionised the role of muscle biopsy in the diagnosis of various
primary and secondary muscle diseases.1 Diagnosis of various subtypes of dystrophies was
further made easy with beginning of immunohistochemical methods in 1980s. Twenty first
century has brought in a new spectacular progress in utility of muscle biopsy with
commencement of molecular methods. Significance of muscle biopsy is rising with
application of new techniques. The treatment of neuromuscular disorders is also
undergoing a parallel and dramatic change with promising genetic therapeutic approaches.
Accurate diagnosis of the underlying neuromuscular disease is the need of the day and
muscle biopsy forms a gold standard in diagnosis of these diseases.
The indications and techniques of muscle biopsy are discussed in detail in another chapter.
Close interaction between pathologist and clinician is necessary for optimal utilization of
muscle biopsy sample to get diagnostic information. The muscle biopsy should be planned
only after relevant clinical and family history, physical examination findings, laboratory
tests including electromyography (EMG), creatine phosphokinase (CPK) and relevant
biochemical or serological tests.

2. Site of muscle biopsy

It is necessary to sample a muscle which is clinically involved. This is decided by clinical
examination, course of progression of disease and sometimes by imaging studies. It is
imperative to biopsy a muscle which is moderately involved. Biopsy from severely affected
muscle will only show fat and fibrosis and minimally involved muscle may lack diagnostic
histological features. Biopsy has to be taken from muscle belly and avoided from tendon
insertion site as it will show central nuclei, variation in fibre size and endomysial fibrosis
mimicking myopathy. Muscle site traumatized by EMG needle, sites of recent injections and
previous surgery should also be avoided. 2
In most of the proximal myopathies and generalised/systemic diseases; vastus lateralis is
the standard muscle biopsied by international consensus. The site is suitable for biopsy as it
is away from major vessels and nerves. 3 The other muscles that are good choices for biopsy
are biceps and gastrocnemius. Tibialis anterior is sampled when indicated by imaging
studies. Deltoid muscle biopsy is usually avoided as it is a site for injections and may not be

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16 Muscle Biopsy

involved in all diseases. It is always better to standardize the biopsy from a particular site in
the laboratory as the fiber type distribution varies from each site. Biopsies obtained from
unusual sites during surgery pose problems for orientation, fiber typing etc.

3. Technique of biopsy
The biopsy can be a needle biopsy or open biopsy. The needle biopsies are dealt within
another chapter in detail. Though needle biopsies have largely replaced open biopsies in
most parts of the world, certain laboratories still favour open biopsy technique due to
feasibility of the procedure and it is usually free of any surgical complications and most
importantly because a bigger piece of muscle is available for examination. The sample is
kept on a saline soaked gauze piece and transported to the laboratory immediately. It
should not be floating in the saline to avoid artefacts.

4. Processing of sample
Orientation of the fibers is of utmost importance since most of the information is provided
by transverse sections. The biopsy should be oriented under a dissecting microscope and
sample is divided as follows:
1. For electron microscopy, 2-3mm fragments are kept in cacodylate buffered
glutaraldehyde and preserved at 4oC.
2. For cryosections, biopsy piece is fresh frozen in isopentane cooled in liquid nitrogen
(-170 oC to -180oC) and then sections are cut in cryostat at -18oC to -20oC. These sections are
stained with Hematoxylin and Eosin (H&E), Masson trichrome, Modified Gomori’s
trichrome (MGT). The various enzyme histochemial stains done include myosine
adenosine triphosphatase (ATPase) preincubated at PH 9.4, 4.6 and 4.3, succinate
dehydrogenase (SDH) and Nicotinamide adenine dinucleotide-Tetrazolium reductase
(NADH-TR). Other stains like Per-iodic acid Shiff (PAS), Oil red O, acid phosphatase,
cytochrome oxidase, acid maltase and myophosphorylase are done as and when indicated.
3. A part of biopsy is used for routine processing after fixing in buffered formalin
4. For molecular biology, biochemical and genetic analysis, a small tissue is preserved in -
80oC. 1,3,4
5. The fresh unfixed muscle is used for
a. Detection and quantification of proteins by Gel electrophoresis
b. Quantification of individual proteins to confirm a deficient or altered protein and
provide a precise quantitative measurement by western blot
c. Demonstrate gene mutations by Polymerase chain reaction (PCR), fluorescent in
situ hybridisation (FISH) and others. These techniques are particularly useful in the
diagnosis of muscular dystrophies.
The biochemical evaluation of muscle for respiratory enzymes and mitochondria are useful in
the evaluation of mitochondrial diseases. These are dealt with in greater detail in other chapters.

5. Normal anatomy
Normal muscle is composed of a number of fascicles which are bound by epimysium and
each fascicle in turn is composed of muscle fibers and wrapped by collagen, called
perimysium.(Figure 1) The arterioles, nerve bundles, venules and muscle spindles are

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Approach to the Interpretation of Muscle Biopsy 17

located in the perimysium. In a child, the muscle fibers are rounded and in an adult, the
fibers are polygonal opposed to each other with very little intervening stroma. Myocytes are
syncitial and the nuclei are seen subsarcolemmaly. However, 3-4% of internal nuclei are
normal. Satellite cells are seen closely applied to the periphery of myofibers. The connective
tissue within the fascicle is called endomysium and contains capillary sized blood vessels.

Fig. 1. (A) Fascicular architecture of the muscle with endomysium, perimysium. (H&EX40)
(B) The polygonal muscle fibers with subsarcolemmal nuclei (H&EX200)

The interpretation of muscle biopsy will be dealt with according to the type of stain used.
The summary of stains and their interpretation is given in Table 1.
Stain Use
Hematoxylin and Eosin General architecture and histology
Masson Trichrome Collagen, fibrosis
Modified Gomori’s trichrome Red ragged fibers, nemaline rods, nuclei, myelinated fibers
Per iodic acid Schiff Glycogen
Oil red O Neutral lipid
Acid Phosphatase Lysosomal enzymes, necrotic fibers
Crystal violet Amyloid
ATPase PH 9.4 Type 1 fibers pale
Type 2 fibers dark
ATP ase 4.6 Type 1 fibers dark
Type 2 fibers pale
NADH Sarcoplasmic structural details
SDH Oxidative enzyme activity
Cytochrome C Oxidase Mitochondrial enzyme activity
Table 1. Summary of various stains used in interpretation of muscle biopsy

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18 Muscle Biopsy

6. Histochemistry
6.1 Hematoxylin and eosin
This stain helps in evaluation of general architecture of the muscle and variation in the
morphology of individual fibers.
H&E is basically used to look at the following changes in muscle:
1. Variation in fascicular architecture
2. Variation in fiber size and shape
3. Necrosis and degeneration of muscle fibers
4. Nuclear characteristics
5. Type and distribution of inflammatory infiltrate
6. Interstitial changes
The architecture of muscle fascicles is assessed on a scanner and the adipose tissue
infiltration and fibrosis are noted. The pathological changes if any are noted. Diffuse pattern
of involvement is seen in dystrophy, focal in neurogenic and patchy in inflammatory
myopathies. Extent of adipose tissue infiltration and fibrosis depend upon the duration
of disease and degree of muscle fiber atrophy and contribute to loss of fascicular
architecture.
In a normal muscle, there is minimal variation in fiber size which depends on age, gender
and muscle. The fiber type variation may be atrophy or hypertrophy and it may selectively
involve type 1 or type 2 fibers. The involvement may be diffuse or focal.

Fig. 2. (A) Large group atrophy H&EX40 (B) Small group atrophy H&EX40 in neurogenic
lesions

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Approach to the Interpretation of Muscle Biopsy 19

Fig. 3. Perifascicular atrophy in dermatomyositis H&EX40

The atrophic fibers may involve entire fascicle (large group atrophy), small groups of
muscle fibers (small group atrophy) or as single fibers. Sometimes all the fibers may be
atrophic. These patterns are seen in neurogenic atrophy. (Figure 2) When the atrophic fibers
are distributed at the periphery of a fascicle, it is called perifascicular atrophy which is
characteristically seen in dermatomyositis, especially juvenile type. (Figure 3) Diffusely
distributed atrophic fibers are seen in dystrophies. Atrophy involving selectively type 1
fibers is seen in congenital myopathies, myotonic dystrophy and rheumatoid arthritis.
Fiber hypertrophy is seen in athletes and as compensatory phenomenon in neurogenic
atrophies also. They are important findings in dystrophy, especially Limb girdle muscular
dystrophy (LGMD). Hypertrophy beyond a particular size leads to splitting. Fiber splitting
result in a group of small fibers may be mistaken for small group atrophy. (Figure 4)

6.2 Fiber shape

In normal adult muscle, the muscle fibers are polygonal and in an infant the fibers are
rounded. In infants and children there is very little endomysial connective tissue. The fibers
become rounded in muscular dystrophies and become angulated and atrophic in denervation.

6.3 Position and number of nuclei

In a normal muscle, nuclei are subsarcolemmal. They are small, oval and dark staining.
However, about 3% of fibers in transverse section may show internal nuclei. Large number

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20 Muscle Biopsy

Fig. 4. Split fibers H&EX200

of internal nuclei suggests a myopathy and transverse section is best to assess the same.
Dystrophies show about 10-30% internal nuclei and myotonic dystrophy is characterized by
profuse number of internal nuclei of about 60%.
Myotubular/centronuclear myopathy shows more than 30% of fibers showing single
centrally placed nulei. (Figure 5) Chronic neuropathies like Charcot-Marie-Tooth disease
also shows large number of central nuclei. Not only increase in number, the character of
nuclei may also vary in various conditions. Vesicular nuclei with prominent nucleoli and
transparent nucleoplasm are seen in regenerating fibers, in myopathies and in central
nucleus of myotubular/centronuclear myopathy. Tigroid nuclei with granular and clumped
chromatin are usually seen in neuropathies and in myotonic dystrophy. Pyknotic nuclei
which are dark staining and shrunken are seen in groups with clumping of chromatin.
These are seen in neurogenic atrophies and limb girdle dystrophies.

6.4 Necrosis, degeneration and regeneration

A necrotic fiber is pale stained on H&E and infiltrated by phagocytes. This is called
myophagocytosis. (Figure 6) This is usually seen in myopathies especially dystrophies
like Duchenne muscular dystrophy (DMD). These fibers are highlighted by acid
phosphatase and esterase reactions. Sometimes necrotic fibers are seen in inflammatory
myopathies, paraneoplastic necrotizing myopathies, after rhabdomyolysis and in acute
neuropathies.

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Approach to the Interpretation of Muscle Biopsy 21

Fig. 5. (A) Muscle fibers showing central nuclei (B) The longitudinal section of the muscle
showing central row of nuclei

Fig. 6. (A) Myophagocytosis H&EX200 (B) Hyaline fibers H&EX200

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22 Muscle Biopsy

A hyalinised fiber is a fiber which has lost its cross striations, has homogenous pale
cytoplasm. (Figure 6) Usually these fibers are rounded. They are usually seen in
dystrophies. They are highlighted on MGT and Masson trichrome stains.
The granular fiber on H&E shows a coarse granular bluish cytoplasm and represents the
ragged red fibers of mitochondrial myopathy on MGT.
Splitting of fibers is seen when a hypertrophic fiber crosses a particular size limit. The nuclei
first migrate along the split and large fiber results in a number of small fibers. Fiber splitting
is seen normally at tendinous insertion. It is a feature of LGMB and other myopathies and
some chronic neuropathies like Charcot-Marie-Tooth disease.

6.5 Interstitial changes

In a normal muscle, the fibers are opposed to each other with very little connective tissue in
the endomysium. In muscular dystrophies following myophagocytosis, there is pericellular
fibrosis. Fibrosis occurs due to a variety of extracellular matrix proteins and fibrosis occurs
in all types of dystrophies, some form of neurogenic atrophies and central core disease also.
Adipose tissue infiltrates usually occurs after muscle atrophy. It is more common in DMD
but occurs in other dystrophies and late stages of neurogenic atrophies and congenital
myopathies. The degree of fibrosis is well brought out by Masson trichrome stain. (Figure 7)

Fig. 7. Pericellular fibrosis highlighted by Masson trichrome. MTX100

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Approach to the Interpretation of Muscle Biopsy 23

6.6 Inflammatory cell infiltrates

Normal muscle is devoid of any inflammatory cells. Cellular infiltrates are seen in
inflammatory myopathies like dermatomyositis, inclusion body myositis (IBM). (Figure 8)
Necrotic muscle fibers are invaded by mononuclear cells which are seen in almost all
dystrophies. Inflammatory cells can occur in toxic, necrotizing and dystrophic muscle
diseases especially fasioscapulohumeral dystrophy (FSHD), DMD, dysferlinopathy and
other LGMDs apart from inflammatory myopathies.

Fig. 8. (A) Inflammation around non necrotic fibers in IBM H&EX40 (B) Perivascular
inflammation in dermatomyositis. H&EX40

The infiltrate is composed of B ells, CD4 positive cells and dendritic cells in
dermatomyositis; CD 8 positive cells, dendritic cells and macrophages in polymyositis and
IBM which can be demonstrated by immunohistochemistry.
The modified Gomori’s trichrome (MGT) stain is useful to stain the red ragged fibers; the
hallmark of mitochondrial myopathy. (Figure 9) Red ragged fibers are also seen in other
conditions like dystrophies (LGMD), dermatomyositis, older individuals and Zidovudine
associated myopathy in HIV patients. 5,6
Tubular aggregates and cytoplasmic bodies are nonspecific and are seen with MGT as red.
(Figure 10) Tubular aggregates are seen in periodic paralysis, dysferlinopathy, exertional
myalgia etc. Cytoplasmic bodies are seen in collagen vascular disease, IBM and others.

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24 Muscle Biopsy

Fig. 9. Red ragged fibers of mitochondrial myopathy MGTX200

Fig. 10. Tubulofilamentous inclusions MGTX400

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Approach to the Interpretation of Muscle Biopsy 25

Rod bodies characteristically stain red with MGT.(Figure 11) The rods are delicate and
accumulate subsarcolemmaly. They stain negative with ATPase, NADH and SDH as they
lack myosin and mitochondria. Rods are characteristic of nemaline myopathy but also seen
in central core disease and various other diseases which include neurogenic disorders
(amyotrophic lateral sclerosis, spinal muscular atrophy, undefined), inflammatory
myopathies (dermatomyositis, polymyositis, periarteritis nodosa), metabolic myopathy
(mitochondrial myopathy), muscular dystrophy (LGMD) and some undefined myopathies. 7

Fig. 11. Rod bodies seen in subsarcolemmal and perinuclear position in a case of nemaline
myopathy. MGTX400

MGT also stains nuclei and myelinated fibers.

The per-iodic-acid Schiff (PAS) and Oil red O demonstrate glycogen and neutral lipid
respectively. (Figure 12) These two stains are useful for metabolic myopathies. Acid
phosphatase identifies lysosomal enzymes and hence identifies necrotic fibers. Masson
trichrome is useful to demonstrate fibrosis and fibrinoid necrosis. Congo red and crystal
violet stains demonstrate amyloid.
Vacuoles
Vacuoles are of two types- one type contains some material within and the other appears as
just empty spaces. The former are called as rimmed vacuoles and on H&E they contain
basophilic granular material and on MGT they appear as having red granules.(Figure 13)
They appear in number of conditions like IBM, distal myopathies, oculopharyngeal
muscular dystrophies, myofibrillar myopathies and others. In glycogen storage disease,
vacuoles appear on H&E. The vacuoles are seen in acid maltase deficiency of childhood
(Pompe’s disease) and adulthood (McArdle’s disease) and Glycogenses V.

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26 Muscle Biopsy

Fig. 12. (A) Vacuolated cytoplasm in glycogen storage disease.H&EX100.Inset: Intracellular

glycogen content. PASX200 (B) Small vacuoles in the sarcoplasm of muscle fibers in lipid
storage myopathy. Inset: lipid droplets stained red by Oil Red O. Oil Red OX200

Fig. 13. (A) Rimmed vacuoles showing basophilic rimming. H&EX200 (B) Rimmed vacuoles
showing red granular rimming. MGTX400

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Approach to the Interpretation of Muscle Biopsy 27

The diagnosis can be established by demonstrating absence of acid maltase and

phoshphorylase respectively. Excess glycogen accumulation in vacuoles and in the fibers
can be demonstrated by PAS stain in glycogenoses. Similarly, lipid accumulation is
demonstrated in vacuoles or in the fibers in carnitine deficiency or in disorders of
mitochondrial beta oxidation. They show cytochrome C oxidase enzyme deficiency.

7. Enzyme histochemistry
ATPase: In myosine ATPase preincubated at PH 9.4, type 1 fibers are pale and type 2 fibers
are dark. At PH 4.6 and 4.3, the reaction is reversed and type 1 fibers are dark and type 2a
and 2b fibers are light with variable intensity. Owing to these staining characteristics on
ATPase, this stain is used to demonstrate abnormalities in fiber types and distribution of the
two types of fibers. (Figure 14)

Fig. 14. ATPase at PH 9.4 showing checkerboard pattern with pale Type 1 fibers and dark
Type 2 fibers. ATPX100

In muscles like vastus lateralis, type 1, 2a and 2b are one third each. Type 1 and 2 fibers are
intermixed in a checkerboard pattern. Type 1 fibers of more than 55% is said to be type 1
predominance and similarly type 2A and type 2B each of 55% constitute predominance of
that fiber subtype. Type 2 predominance is called when type 2 fibers are more than 80%.
Type 1 predominance indicates a myopathy; either dystrophy or congenital myopathy
whereas type 2 predominance in motor neuron disease.
Type I predominance is normally seen in gastrocnemius and deltoid and hence caution
should be exercised in interpreting biopsies from these sites.

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28 Muscle Biopsy

In addition to type predominance, fiber type grouping which is characteristic of neurogenic

lesions is also best assessed on ATPase stain.
Atrophy of particular type of fibers is also evaluated by ATPase. Selective type 1 fiber
atrophy is seen in congenital myopathies and myotonic dystrophy. Selective type 2 atrophy
is common and is seen in many conditions. These include steroid myopathy, disuse,
polymyalgia rheumatica, collagen vascular diseases, pyramidal tract disease, mental
retardation, myasthenia gravis etc. 1,2 Type 2 atrophy usually involves type 2B or both type
2A and type 2B; however only type 2A atrophy is uncommon. 1
Fiber specific hypertrophy is very uncommon.
Subtle changes in fiber size are best made out by plotting histograms. 1
SDH and NADH
These enzyme histochemical stains bring about various structural abnormalities of muscle
fibers and being oxidative enzymes are important in diagnosis of mitochondrial myopathies.
The abnormal fibers of mitochondrial myopathy are seen as “blue ragged fibers “on SDH
and NADH and they are the counterpart of red ragged fibers on MGT. (Figure 15) COX is a
mitochondrial enzyme and its activity is absent in mitochondrial myopathy or
abnormalities. A combination of COX-SDH brings about more number of abnormal fibers in
mitochondrial myopathy. 8

Fig. 15. (A) Blue ragged fibers of mitochondrial myopathy. SDHX100 Inset: The same fibers
on higher magnification. SDHX400 (B) The same muscle showing more abnormal fibers on
COX-SDHX40

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Approach to the Interpretation of Muscle Biopsy 29

NADH-TR highlights the sarcoplasmic reticulum and oxidative enzyme activity, Structural
abnormalities like cores, targets, whorles, lobulated fibers are best seen on NADH-TR. SDH
is an oxidative enzyme and mitochondrial abnormalities are highlighted by SDH. Cores and
lobulated fibers are also seen on SDH.(Figure 16) Acid maltase, myophsprylase are done as
and when indicated clinically (glycogen storage diseases).The myofibrillar abnormalities
include central/minicores, target, targetoid fibers, ring fibers, whorled fibers and lobulated
fibers.

Fig. 16. Central cores in a case of central core disease. SDHX100

Central cores are seen as pale areas of staining on oxidative enzyme staining like NADH
and SDH. The cores are usually single and central but may be eccentric and multiple. They
are not seen on H&E, ATPase, MGT but seen on phosphorylase. The rim of the core is
devoid of mitochondria and hence lacks oxidative enzyme activity. Central cores are seen
usually in type 1 fibers. Central cores are seen in many fibers in central core disease. Central
cores are not limited to central core disease as they are seen in hypertrophic
cardiomyopathy associated with missense mutations in the beta myosine heavy chain gene,
MHY7 9, autosomal dominant myopathy associated with ACTA 1 gene mutations. 10
Multiple minicores seen on oxidative enzyme reactions both in transverse and longitudinal

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30 Muscle Biopsy

sections are seen in multiminicore disease (MmD) and it is a histopathologic continuum

with central core disease. Many cases of MmD are caused by recessive mutations in the
selenoprotein NI (SENPI) gene 11 and same due to recessive RYR1 mutations. 12,13
Target fibers are characterised by three distinct zones where central zone is devoid of
oxidative enzyme activity, middle zone of intense activity and outer zone of intermediate
activity. They are usually seen in type 1 fibers when the three zones are not clearly
demarcated, the target fibers resemble central cores and they are called targetoid fibers.
Target fibers are a feature of chronic neuropathies.
Moth eaten fibers show irregular disruption of myofibrillar network. These are seen on
NADH or SDH and may be mistaken for minicores or cores. Moth eaten fibers are seen in
dystrophies including LGMD, congenital muscular dystrophy and various myopathies
including dermatomyositis. (Figure 17)

Fig. 17. (Left) Moth eaten fiber on H&E X400 and (Right) on SDHX200

Ring fibers and whorled/coiled fibers are due to various patterns of disarray of myofibrils.
They are seen in various dystrophies. (Figure 18) Ring fibers are seen in myotonic dystrophy
whereas whored fibers are seen in LGMD and chronic neuropathies.

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Approach to the Interpretation of Muscle Biopsy 31

Fig. 18. Whorled fibers in a case of limb girdle muscular dystrophy H&EX200. Inset: The
same fiber on SDHX400

Lobulated fibers show intense oxidative enzyme activity at the periphery of the fiber and
usually involve type 1 fibers. They are nonspecific and are seen in many conditions which
include LGMD particularly calpainopathy, congenital muscular dystrophy, mitochondrial
myopathy and others.

8. Conclusion
Muscle biopsy is essential for accurate diagnosis and treatment. Optimal utilization of the
sample with appropriate stains and study of the pathologic features is important for making
a diagnosis. Accurate interpretation of muscle biopsy guides appropriate
immunohistochemical and molecular genetic studies.

9. References
[1] Dubowitz C, Sewry CA. In: Dubowitz C, Sewry CA (eds.) Muscle biopsy. A practical
approach. Philadelphia, USA: Elsevier, Saunders, 2007.
[2] Engel WK. Focal myopathic changes produced by electromyographic and hypodermic
needles. Archives of Neurology (Chicago). 1967;16:509-11
[3] Kakulas BA, Adams RD. Diseases of muscle. Pathological foundations of clinical
myology. 4th ed. Philadelphia: Harper and Row, 1985.

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32 Muscle Biopsy

[4] Harriman DGF. Diseases of Muscle. In: Adams JH, Corsellis JAN, Duchen LW, eds.
Greenfield's neuropathology. 4th ed. Edward Arnold, 1984: 1026-96.
[5] Schoffner Jm, Lott Mt, Lezza Ams, Seibel P., Ballinger Sw, Wallace Dc. Myoclonic
epilepsy and ragged-red fiber disease (MERRF) is associated with a mitochondrial
DNA tRNAlys mutation. Cell 1990; 61: 931-37
[6] Arnaudo E; Dalakas MC; Shanske S; Moraes CT; Di Mauro S; Schon EA. Depletion of
muscle mitochondrial DNA in AIDS patients with zidovudine-induced myopathy.
Lancet 1991;337:508-10.
[7] Shoei-Show Liou, Shun-Sheng Chen, Itsuro Higuchi, Hidetoshi Fukunaga, Mitsuhiro
Osame. Diagnostic role of nemaline rod in neuromuscular disease. Acta Neurol
Sinica 1992;1: 218-23.
[8] Fananapazir L, Dalakas MC, Cyran F, Cohn G, Epstein ND. Missense mutations in the
beta-myosin heavy-chain gene cause central core disease in hypertrophic
cardiomyopathy. Proc Natl Acad Scie U S A. 1993;90:3993-7.
[9] Kaindl AM, Rüschendorf F, Krause S, Goebel HH, Koehler K, Becker C, Pongratz D,
Müller-Höcker J, Nürnberg P, Stoltenburg-Didinger G, Lochmüller H, Huebner A.
Missense mutations of ACTA1 cause dominant congenital myopathy with cores. J
Med Genet. 2004;41:842-8.
[10] Ferreiro A, Fardeau M. 80th ENMC International workshop on muti-minicore
disease:1st International MmD workshop. 12-13 May 2000, Soestduinen, The
Netherlands. Neuromuscular Disorders 2002;12:60-8.
[11] Monnier N, Ferreiro A, Marty I et al. A homozygous splicing mutation causing
depletion of skeletal muscle RYR1 is associated with multi-minicore disease
congenital myopathy with opthalmoplegia. Human Molecular Genetics.
2003;12:1171-78.
[12] Jungbluth H, Muller CR, Halliger-Keller B et al. Autosomal recessive inheritance of
RYR1 mutations in a congenital myopathy with cores. Neurology 2002;59:284-7.

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 Muscle Biopsy
Edited by Dr. Challa Sundaram

ISBN 978-953-307-778-9
Hard cover, 154 pages
Publisher InTech
Published online 05, January, 2012
Published in print edition January, 2012

Investigation of muscle diseases has changed dramatically with the understanding of genetic basis of a wide
range of muscle diseases. Muscle biopsy has become a powerful tool not only to provide diagnosis but to
make tissue available for genetic studies and to basic scientists for biomedical research. Accurate
interpretation of muscle biopsy to detect cell dysfunction/ damage/death or absence / abnormality of a protein
or genetic defect by the sophisticated technologies is important to guide treatment of various muscle diseases.
In this book on muscle biopsy various chapters deal with the procedure and interpretation of muscle biopsy, its
use in the culture of myotubes and membrane transport studies.Muscle biopsy is an important technique to
investigate mitochondrial dysfunction and the mitochondrial DNA integrity in oxidation. Phosphorylation in
various metabolic diseases like obesity, type 2 diabetes mellitus and peripheral vascular disease is explored in
the other chapters with detailed descriptions on methodology. This book provides the advances in the basic
techniques of muscle biopsy for a neuroscientist.

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C. Sundaram and Megha S. Uppin (2012). Approach to the Interpretation of Muscle Biopsy, Muscle Biopsy, Dr.
Challa Sundaram (Ed.), ISBN: 978-953-307-778-9, InTech, Available from:
http://www.intechopen.com/books/muscle-biopsy/approach-to-the-interpretation-of-muscle-biopsy

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